Saja Tunkara’s conviction of his imminent death grew in tandem with the lump on the right side of his neck that swelled from the size of a quarter to an egg within a few months. The feeling of sharp needles piercing his skin radiated from his neck to his arm as the mass pressed against his nerves. It’s a pain that Tunkara will never forget. “I cried pretty much every night to get myself to sleep,” he recalled.

A routine checkup at Harborview Medical Center on Oct. 13, 2017, revealed the lump that he and his wife, ShaCorrie, said was scheduled to be surgically removed on Jan. 25. But two weeks before the appointment, an unexpected visit from U.S. Immigration and Customs Enforcement (ICE) officers during his probation check-in at downtown Seattle’s Department of Corrections thwarted Tunkara’s plans.

Tunkara, a native of Sierra Leone, overstayed his 2001 tourist visa and received a final removal order in April 2012, an ICE spokesperson wrote Seattle Weekly. But he said that his English was poor during his removal hearing and he didn’t understand the Senegal dialect of the translator assigned to him at court.

“If I knew what I know today I would have left. Better than what I’m going through today,” said Tunkara, the lenses of his black-rimmed glasses reflecting the glow of the tablet. The 39-year-old talked to Seattle Weekly through a video call in the cafeteria of Tacoma’s Northwest Detention Center (NWDC) — a privately run immigrant detention facility — the room’s bright lights casting a glow on his tuft of dark hair.

Tunkara’s burgeoning lump was on his mind as he arrived at the detention center’s booking area on Jan. 10. “I have a tumor in my neck, so I just wanted to let you know so I hope that you’re not planning on deporting me just yet,” Tunkara informed a guard. It had been years since he last returned to Gambia, the West African country where his parents immigrated when he was 2 years old, but Tunkara was convinced that the low quality of health care would render him “a dead man walking” if he sought medical treatment there.

Despite the NWDC staff’s stated commitment to address his medical needs in a timely fashion, Tunkara’s scheduled surgery date came and went without receiving any treatment while the persistent pain shot through the right side of his body. Medical documents ranging from Jan. 28 to March 2 reveal that medical staff employed by the ICE Health Service Corps gave Tunkara anti-inflammatory medication and Tylenol for severe pain that he sometimes described to medical staff as a 10/10. Three months passed before his tumor was removed on April 27, according to University of Washington Medical Center documents.

Tunkara’s experience of delayed or absent medical care reflects the accounts of dozens of other people detained at the nation’s fourth largest immigrant detention center as they await immigration proceedings. While ICE maintained that the 1,575-bed facility offers sufficient medical and mental health care to detainees, Tunkara and others in custody said they fear their last breaths could be drawn in the facility.

Medical documents, court records, and interviews with five current and one former NWDC detainees revealed a multitude of complaints about insufficient medical care, including tumors that grew exponentially while in custody, the denial of surgery for hernias, several-month delays on the stocking of medical devices such as catheters, the administering of ibuprofen for severe pain, and forced isolation of people with mental health issues.

These problems show no sign of slowing down. The Trump administration has ramped up its efforts to increase deportation through policies such as a 2017 executive order that expanded who is considered a priority for deportation and has eased the government’s ability to deport individuals without due process.

To accommodate the influx of incarcerated immigrants, ICE issued a notice in June that it would seek up to 15,000 additional beds in privately run detention facilities. Subsequently, the Trump administration requested $2.7 billion for fiscal year 2019 from Congress, to hold more than 50,000 people in immigration detention centers nationwide per day.

But as the need for detention facilities has increased, companies contracted by ICE to run the centers have come under increased scrutiny by immigration attorneys and advocates who question the private prison system’s transparency and the medical attention provided to those in their custody. Interviews with immigration attorneys, advocates, professors, families of detainees, and politicians paint a portrait of an opaque medical system at NWDC that boasts flawed inspections, minimal outside oversight, and data that is virtually sealed from public view.

The NWDC’s operator and ICE portray a different narrative. Although the NWDC is privately owned and operated by Florida-based GEO Group under a contract with ICE, medical care is provided directly by the federal government through ICE’s Health Service Corps. “GEO is not involved in the provision of medical care nor does our company have any contracts or subcontracts for that purpose…” GEO Group spokesperson Pablo Paez wrote Seattle Weekly in an email.

As for Tunkara’s care, ICE maintained that Health Service Corps staff became aware of the tumor during Tunkara’s comprehensive medical assessment within 24 hours of him arriving at NWDC in January, and that they took the benign lump seriously. “During his time in ICE custody, Mr. Tunkara has received timely and appropriate medical care consistent with the agency’s rigorous performance-based national detention standards,” an ICE spokesperson wrote to Seattle Weekly. “Prior to entering ICE custody, surgery to correct the condition was deemed elective, and even so, ICE’s Health Service Corps worked with a surgeon to secure a surgery date for Mr. Tunkara. ICE went to significant lengths to ensure Mr. Tunkara received this surgery, including delaying his ordered removal to Gambia. Any additional medical concerns were also addressed, as ICE does for all individuals in its custody.”

Located on Tacoma’s Tideflats, NWDC sits adjacent to land that the Environmental Protection Agency (EPA) designated as a Superfund site—one of the nation’s most toxic areas due to the dumping of hazardous waste—referred to as the “Tar Pits.” The detention center complex was eerily quiet during a recent visit, somehow immune to the din of traffic on a state highway less than a quarter mile away. A barbed wire fence glistened in the sun and encased the sprawling complex, separating it from an active rail line situated 8 feet away from yet another fence recently erected by the City of Tacoma in response to protests on the public right-of-way. Plumes of smoke rising from industrial plants juxtaposed the billowing American and Washington state flags that mark the center’s entrance.

The alleged poor quality of medical care that detainees receive at the NWDC isn’t the only health-related problem that they face. Its location in Tacoma’s Port Maritime and Industrial zone poses a concern to Megan Ybarra, University of Washington associate professor of geography, who said that detainees have shared accounts of exacerbated asthma, respiratory illnesses, and rash outbreaks that could be linked to the center’s proximity to environmental hazards.

Advocates’ concerns about the risks associated with an industrial zone materialized on Sept. 17, when a fire that erupted at nearby Simon Metals sent noxious smoke wafting throughout NWDC. Several city and county departments such as the Tacoma-Pierce County Health Department and the city’s fire department posted warnings on their websites and social media recommending that residents avoid going outdoors if they noticed smoke after the fire. The Port of Tacoma even stopped its terminal operations until the afternoon, according to KUOW.

Detainees said that they were some of the first ones to notice the fire that was burning less than a mile away, after they awoke to the smell of burning plastic early that morning. “The guards put us on lockdown,” one person in detention, who asked to remain anonymous for fear of retaliation, told Seattle Weekly during a video call later that day. “A lot of people were coughing.” He said his attorney eventually notified him of the fire, although GEO guards didn’t provide the detainees with details or advice about how to protect themselves from the toxic fumes.

ICE spokesperson Roman maintained that ICE followed proper protocol during the Simon Metals scrapyard fire. “The facility ensures that air circulation within the facility meets or exceeds required standards and provides access to onsite medical staff if detainees have medical concerns,” she wrote to Seattle Weekly. “As reported by the GEO Group, during this event, the Environmental Protection Agency and the Tacoma Hazmat Team monitored the situation and no evacuation orders for people and/or businesses near the fire location were given by Tacoma Fire Department.”

Smoke from nearby plants can be seen at NWDC’s entrance. Photo by Melissa Hellmann

On the inside, Tunkara said he regularly views smoke from nearby plants while he and other people in detention play basketball or lift weights during their daily hour of outdoor recreation. Although he personally wasn’t affected by the Sept. 17 fire, Tunkara has developed asthma that requires him to use an inhaler up to four times a day since arriving at NWDC. On the video call, he gripped his chest and gasped for breath to demonstrate the worst of his asthma attacks.

Asthma is not listed in Tunkara’s medical records from Harborview Medical Center that range from 2003 to a few days before he went into federal custody. Yet in ICE’s Health Service Corps records from March to August 2018 that were provided to Seattle Weekly by ShaCorrie, asthma was noted in Tunkara’s past medical history. ICE medical records also indicate that he has received an Albuterol inhaler over the past seven months.

Meanwhile, the erstwhile tumor in his neck continues to cause Tunkara problems. He believes that the delayed surgery has caused permanent decreased mobility in his arm. According to Tunkara, he was only sent to physical therapy three times by late September, and had his last visit on Sept. 8 because medical staff said their schedule was too tight to continue taking him.

To demonstrate its impaired functionality, Tunkara struggled to bend his right arm over his shoulder and fell short of touching his back with his hand. For comparison, he easily glided his left arm over his shoulder and reached for the back of his navy blue uniform, flashing a brief smile like the victor in a game of tag. “I thank you ICE for ruining my life; for ruining my hand,” he quipped.

Differences in opinion about the need for medical treatment at the detention center are also at the heart of discrepancies. A May medical document from CHI Franciscan Health — a medical clinic in Tacoma — showed that Tunkara’s physical therapist recommended that he receive physical therapy twice a week for 12 weeks. But by July 23, an ICE spokesperson wrote Seattle Weekly that Tunkara had received physical therapy five times, and that the surgical team that eventually removed his tumor in April hadn’t recommended how often he receive the treatment.

Tacoma’s detention center isn’t the only facility in which detainees complain about insufficient health care. The complaint is so widespread at facilities throughout the nation that Freedom for Immigrants found that medical negligence was the top grievance that people in immigrant detention had reported to the nonprofit advocacy group.

Their Stories

People detained in the Tacoma detention center are responding to their unmet requests. Recurring medical complaints led 27 people in detention from one pod to send a letter to Washington-based advocacy group NWDC Resistance detailing what they considered insufficient medical care. “We just need more attention for medical needs,” the detainees wrote in a copy of the letter that Seattle Weekly obtained, “a lot of people [have] medical issues and you guys let everything [go] to the last minute and that’s not [right] we don’t want somebody dead beside us just because you guys didn’t do your guys’s job right.” People held in ICE custody have also staged three hunger strikes at NWDC in 2018 alone to call attention to the insufficient health care, among other concerns.

One of the letter’s signers was 49-year-old Odilon Jimenez-Ramos, who said that an accident at the NWDC in March rendered him with injuries that were insufficiently addressed. After he injured his shoulder by falling on the basketball court, he said staff quickly heeded his concerns by giving him ibuprofen for a couple of weeks, followed by two sessions with a physical therapist when the pain didn’t subside. But then staff stopped taking him to physical therapy altogether.

“[Medical staff] said it doesn’t help, but I only went twice,” Jimenez-Ramos said in a soft, languorous voice during a video call from the detention center in mid-September. Dark bangs that swept across his forehead offered a stark contrast to his mottled gray goatee and mustache. People in white uniforms huddled around tables behind Jimenez-Ramos as they intently stared at a football game playing on a TV positioned above his head.

The fall also caused a hernia that he said is being treated with a belt and ibuprofen. “It helps, but I’ve still got pain,” said Jimenez-Ramos, his voice now drowned out by the howls of those watching the game. Since he signed the letter in July, Jimenez-Ramos said the medical staff have scheduled an X-ray and MRI scan for his shoulder. Health Service Corps staff members only seem to address medical concerns when people in detention complain consistently, said Jimenez-Ramos, and the care is often delayed or falls short of fixing the problem. For example, although he started to lose his vision shortly after he arrived in NWDC, he said it took six months to receive glasses. But he said the prescription is too strong for him, his bespectacled eyes gently shut as he talked.

Tunkara also said he was given the wrong eyeglass prescription by medical staff when he complained of becoming nearsighted upon arriving at NWDC. People in detention are referred to an outside provider for an eye exam if a vision problem is identified during a physical examination, ICE spokesperson Roman wrote Seattle Weekly. “If glasses are recommended and a prescription received, glasses will be ordered,” Roman said.

But some people in detention voiced concern that the care they receive could have long-lasting impacts on their health. After living and working in the U.S. for over three decades, Jimenez-Ramos expressed fear that the injuries he incurred at the detention center will prevent him from being able to work if he’s deported to Mexico. “I’m worrying because [of] my hernia and my shoulder. If I don’t fix it, how will I support my family?” He said he’s never had any serious run-ins with the law and that he’s currently applying for an appeal to a deportation order.

In the eyes of ICE, the people in their custody are being detained for violating the country’s immigration laws. In an email, an ICE spokesperson mentioned Tunkara’s arrest record when explaining how he came to be detained.

Some of the six current and former people in detention whom Seattle Weekly interviewed were arrested or convicted of crimes prior to arriving in the detention center, which set in motion their eventual transfer to ICE custody. For instance, Tunkara was charged with domestic violence in 2017, although ShaCorrie told Seattle Weekly she called police during a non-physical argument to settle their dispute and had not intended on him being arrested. Another person in detention named Kelvin Melgar-Alas pleaded guilty to distributing methamphetamine to a confidential source of the FBI twice in 2006, according to court records.

Ricardo Rivas-Martinez is one person in detention who immigrated to Washington to escape violence in his native country of El Salvador and is now seeking asylum. The 46-year-old arrived in the U.S. in 2006 after being stabbed by a gang member while he was driving a bus, Rivas-Martinez said in Spanish through translation provided by his roommate, Erlin Bonilla-Aguilar. Rivas-Martinez eventually found work as a landscaper in Edmonds when the strain of picking up a large tree caused a wrist injury and hernia four years ago. He said he filed a Labor and Industries Department complaint shortly thereafter, which allowed him to get surgery on his wrist and seven months of physical therapy sessions for his hernia in 2017.

But the physical therapy might have done more harm than good. He said during an August video interview that he had scheduled hernia repair surgery for mid-April after a physical therapy session last fall had exacerbated it. But on March 22, Rivas-Martinez was arrested by Lynnwood police on sex offense charges and spent three weeks in jail before being released, according to a Snohomish County Jail booking record. He said he missed his surgery during that time, and could not reschedule it after ICE took him into custody during his drive to work a couple of weeks later.

He said his hernia pain has worsened over the past few months in the NWDC, making it difficult to walk or lift boxes in the facility. Other aches related to injuries suffered in the work accident have also resurfaced because of the care at the center, he said. Rivas-Martinez displayed his slightly bent wrist in front of the camera to demonstrate its decreased mobility, adding that he can’t ball his hand into a fist. In a mid-September video interview, Rivas-Martinez reiterated that he has visited the medical ward multiple times throughout his detention to ask for hernia repair surgery or stronger pain medication, but that medical staff have only given him ibuprofen. He holds out hope of securing a bond hearing that will allow him to get surgery in the near future. “I feel pain all the time,” he said through a translator who asked to remain anonymous. “I only sleep for about two hours every night.”

Without addressing Rivas-Martinez’s individual case, ICE spokesperson Roman stated that a person in detention receives a surgical consultation if medical staff recommend it. “If it is not recommended, ICE Health Service Corps (IHSC) will follow the recommendations of the specialist.”

What’s the Source of the Problem?

The increased arrests of undocumented immigrants and asylum seekers has placed additional pressure for medical services on contractors such as GEO Group, which receives more ICE funding than any other private prison company in the nation. Geo Group had more than $450 million in ongoing contracts with ICE as of July, according to investigative journalism website Sludge.Federal spending data shows that GEO Group’s current contract with ICE to operate the NWDC consists of about 14 percent of the total at $65.7 million – about a $4 million increase from the previous year. The data does not specify how much of the funding goes toward health care, and ICE did not respond to inquiries about the NWDC’s medical care budget.

But the absence of robust external oversight mechanisms and enforcement of standards means that it’s difficult to hold detention centers accountable, researchers and attorneys argue. “The big issue for me is just the complete lack of effective oversight of the institution, so that’s why it’s hard to get the information,” said Angelina Godoy, director of the University of Washington Center for Human Rights. “But more alarming to me than the fact that it’s hard for me to get the information is that it’s hard for anyone.” The center has looked at the human rights consequences of ICE in Washington since early 2017, although the team’s research hasn’t centered on medical care at the NWDC.

The center did glean 911 calls placed by the NWDC between 2015 to 2017 that revealed an overall increase in requests for emergency services with the majority categorized as needing medical assistance. But the results are inconclusive. “It’s really difficult to interpret that data because theoretically they could be calling 911 more this year than last year because they could be more responsive,” Godoy said.

Aside from anecdotes of substandard health care, the inaccessibility to information about medical attention at the NWDC has made it difficult to pinpoint specific holes in the system. “It’s an entirely internal process and one that’s completely opaque to the public, including our elected officials,” Godoy said. “If they’re not giving their information to individual researchers, and they’re not giving information to journalists, and they’re not giving that information to members of Congress, nobody has that information except them.”

In August, Seattle Weekly filed a Freedom of Information Act (FOIA) request for grievances relating to inadequate medical care at NWDC that was not fulfilled by the time of publication. A month later, the University of Washington Center for Human Rights Department went a step further by filing a lawsuit in federal court against the Department of Homeland Security (DHS), ICE and Customs and Border Protection — two DHS subagencies — for their failure to respond to 12 records requests, including the handling of grievances at the NWDC. Seattle Weekly also requested medical records from ICE for detainees Tunkara, Ricardo Rivas-Martinez, and Kelvin Melgar-Alas to verify their claims of medical negligence, but these records were not received by the time of publication.

Washington state and the City of Tacoma also lack jurisdiction over the health care services provided at the detention center. Tacoma-Pierce County Health Department’s oversight role is limited to inspecting food preparation and service, department spokesperson Edie Jeffers wrote to Seattle Weekly. “Northwest Detention Center staff do sometimes consult with Tacoma-Pierce County Health Department disease control staff as a courtesy when there is a communicable disease concern, but they are not required to do so,” she said.

The disease investigation team at the Washington State Department of Health (DOH) has consulted NWDC staff on managing cases of tuberculosis and other infectious diseases, according to DOH, although the scope of personnel’s involvement is usually limited to the occurrence of suspected and confirmed cases.

A potential oversight of federal statute also calls into question the detention center’s authority to legally operate in Tacoma. According to the Immigration and Nationality Act, the U.S. Attorney General must enter into a cooperative agreement with the state or local jurisdiction to construct an immigrant detention center in the area, although no such arrangement regarding the NWDC exists. Instead, ICE entered into a direct contract with GEO Group in order for the private company to run the facility. It remains unclear whether the contract between the federal agency and GEO Group could be legally challenged: “But certainly plausible that the contract is invalid,” Claudia Valenzuela, National Immigrant Justice Center’s Detention Project director, wrote to Seattle Weekly.

ICE spokesperson Roman did not respond to Seattle Weekly’s inquiry regarding the existence of a cooperative agreement between the city or state and the U.S. Attorney General. But she did point to several regular audits and inspections designed to keep Tacoma’s detention center in check. Along with following national guidelines when administering medical care, ICE maintained that Health Service Corps performs its own annual internal audit without notifying the NWDC beforehand. Other annual reviews of the facility are completed by Performance-Based National Detention Standards and the ICE Office of Detention Oversight, while the American Counseling Association and National Commission on Correctional Health Care conducts audits every three years. “The NWDC has consistently passed all of these audits with 100 percent compliance,” Roman wrote.

Tunkara and other immigrants in detention argue that the care is anything but fast, while advocates and attorneys who have worked with people in detention concur. National Immigrant Justice Center is now litigating a FOIA request to receive inspection reports and updated contracts between ICE and private companies that run immigrant detention centers.

“Moreover, ICE does not adequately follow up on identified deficiencies or consistently hold facilities accountable for correcting them, which further diminishes the usefulness of inspections,” Kelly wrote in the report. “Although ICE’s inspections, follow-up processes, and onsite monitoring of facilities help correct some deficiencies, they do not ensure adequate oversight or systemic improvements in detention conditions, with some deficiencies remaining unaddressed for years.”

In fact, a Sept. 2014 ODO inspection of the Northwest Detention Center released by the National Immigrant Justice Center showed that the Tacoma facility only met 11 out of 20 national standards, and the majority of deficiencies were found to be in medical care. Among the most damning of the findings was ODO’s review of five people in detention with mental health referrals, one of whom did not receive an evaluation for a full week. The 2011 Performance-Based National Detention Standards requires that a person in detention who receives a mental health referral will undergo an evaluation with a licensed professional up to 72 hours later.

However, anecdotes from people who are detained show the persistent delay in treatment of people with mental health issues. “ICE’s inspection system has been widely criticized for not actually performing rigorous inspections,” said ACLU of Washington Staff Attorney Eunice Cho, “to the point where these inspections stand for basically nothing at all.”

Cho has long been concerned about the isolation of people with mental health issues at the NWDC. In May, she received a grievance letter from a person detained at Tacoma’s facility named Milaudi Karboau, who witnessed someone with mental health issues being placed in a segregated cell without receiving proper treatment.

“The mentally ill detainee kept screaming, kicking on the sheet-metal wall between me and him yelling, howling and [begging] for medical attention all the time 24/7, keeping me up all three nights and day,” Karboau wrote in the letter. Karboau added that a lieutenant and a SWAT team came to his neighbor’s unit, and “[pepper] sprayed him in his cell until the poor man nearly choked to death and from his cell, the [SWAT team] undressed the mentally ill detainee and threw him in [the] shower handcuffed and run the water on him.”

There are more documented cases of people with mental health issues at NWDC being placed in isolation without receiving proper attention. The ACLU sent Seattle Weekly a copy of an internal NWDC form that revealed another person with schizophrenia who was placed in isolation for 219 days, during which time he didn’t leave the room for recreation or to take a shower. The person’s name and identifying factors were redacted from the document signed Oct. 12, 2017.

The isolation of people with serious mental health conditions is common at ICE-funded facilities throughout the country, according to a recent report by Human Rights Watch, Detention Watch Network, the ACLU and National Immigrant Justice Center. In the joint report, medical experts revealed that substandard medical care caused or played a part in eight of the 15 deaths in immigrant detention centers between December 2015 and April 2017. One person with a known history of schizophrenia detained at Georgia’s Stewart Detention Center had been ordered to spend 20 days in isolation when he killed himself in his cell on the 19th day. The investigation also showed that the detention center’s staff had not given the person the full amount of his prescribed medication.

People with mental health issues aren’t the only ones who complain that staff have not been equipped to address their medical needs. Kelvin Melgar-Alas, a person in detention who has paraplegia, said that medical personnel seemed unaware of his condition when he arrived in July at the NWDC. Originally from El Salvador, the 38-year-old lawful resident has lived in the U.S. for nearly three decades, but became deportable after being convicted of a federal drug offense in 2008. Melgar-Alas originally viewed the detention center as any other federal facility where he had stayed in the past 10 years.

But then he was sent to live in his own small room in the NWDC’s medical ward instead of living near others in the general population for his first 24 hours at the center. “It feels like being disabled is a punishment,” said Melgar-Alas as he shook his head, his sparse beard framed against his white T-shirt. “Why do I have to be in a cold room? There’s no difference between [that and] being in [segregation].” Melgar-Alas eventually joined the general population after he said he begged the NWDC staff to remove him from isolation.

Moreover, medical staff hadn’t ordered the colostomy bags and catheters he needed for his daily life, and neglected to give him the methadone he’d been prescribed for pain relief before entering the detention center. “They knew I was coming, and didn’t have any of my medical supplies, whatsoever,” Melgar-Alas said about the NWDC medical staff in a July video interview.

A shipment of his daily devices were finally delivered on the day he ran out of the two-week supply he’d brought with him from the prison where he had previously stayed, Minnesota’s Federal Medical Center.

In response to Seattle Weekly’s inquiry about Melgar-Alas’s placement in isolation, ICE spokesperson Roman stated that “medical housing is intended to be temporary, therefore in the rare circumstances that a detainee must remain in the medical unit for an extended period, efforts are made to determine if another facility is better suited for their specific needs.” She added that ICE considers individuals’ needs when determining where they will be housed.

As for Melgar-Alas’s complaint that his medical supplies did not arrive in a timely manner, Roman said medical records from other law enforcement agencies sometimes trail behind the detainees. “Depending on the individual case, necessity and availability, ICE may expedite shipping of medical records and devices to the center,” she said.

When contacted in mid-September, Melgar-Alas had received all of his medical supplies and had finally gotten an egg crate mattress topper to prevent bed sores — after asking for one for nearly three months. “At this moment, I can’t really complain about it because they’ve given me everything I need,” he said.

Help From the Outside

Even before NWDC Resistance founder Maru Mora-Villalpando helped start the immigrant advocacy group in 2014, she and other organizers received calls from detainees complaining about insufficient medical care at the facility. Between 2007 to 2013, Mora-Villalpando estimated that about one in three calls that she received from people in detention were related to the medical care they received, while other calls were related to food or immigration proceedings. Since 2014, a majority of the dozen hunger strikes inside NWDC have also concerned medical conditions, she said.

Mora-Villalpando shared details about some of the calls she receives: “The general theme is ‘I already had an injury and you knew when I was being detained, yet you detained me and you said that I would get medical care that I didn’t,’” she said. Others call about receiving ibuprofen for searing pain, or being administered mystery pills that make them sleep all day.

Women face their own set of medical malfeasance in the detention center. One woman’s miscarriage last year called into question the care that she was receiving in the facility. “Something that is also not taken into consideration is how many women are possibly pregnant and detained, how many women are possibly breastfeeding and not being allowed to … provide their children nourishment,” Mora-Villalpando said.

When they’re not supporting hunger strikers, NWDC Resistance organizers bring to light individual cases of inadequate availability of health care services. The organization’s efforts in elevating Angel Padilla’s case in 2016, for instance, helped him be released from NWDC on bond to have a cancerous tumor in his kidney removed, which ultimately saved his life.

“They kept passing the ball around so that they didn’t have to do anything,” Padilla said while reflecting on his care at the NWDC in a recent phone interview from California, where he now lives after recovering from cancer. He claimed he filed several grievances while he was detained at the NWDC to obtain his medical records and to complain about receiving Tylenol to treat what he described as “a shooting pain” that “radiated up my spine and down to my toes.”

One reason that Padilla’s case of getting released on bond is not a more common conclusion is because its hard to come by legal representation for people in detention. “These are extremely fact-intensive and challenging cases given the barriers that detainees face by ICE and the local detention center, and unfortunately private attorneys are usually not able to take on these cases,” Cho from ACLU said.

Mora-Villalpando and other organizers met with Tacoma City Councilmember Conor McCarthy in August to discuss the conditions within the center. “What for me is problematic as a policymaker … is that we don’t have at this time, what I would say is a sufficient process to ensure that people are treated humanely at this facility,” Councilmember McCarthy told Seattle Weekly in late September. “What I’d like to see the city consider is additional local oversight of the treatment of the people at this facility, because right now its lacking.”

As the Trump administration continued its rhetoric on the need for detention centers at the national level, U.S. Reps. Adam Smith (D-WA) and Pramila Jayapal (D-WA) introduced legislation in Oct. 2017 to end the use of private detention centers. The Dignity for Detained Immigrants Act, H.R. 3923, would repeal mandatory detention and require a more rigorous inspection process at facilities. The legislation was referred to the Subcommittee on Immigration and Border Security last fall, although it’s seen no movement since.

In the meantime, the NWDC Resistance organizers hold regular demonstrations outside of the facility in response to the impenetrability of the local center and the increasingly labyrinthine immigration system. On a Saturday in early September, ShaCorrie Tunkara stood under a white tent stationed by a fence leading to the complex’s entrance. On a nearby sidewalk, the words “State sanctioned concentration camp,” were scrawled in purple and pink chalk with a pink arrow pointing to the facility.

Holding a megaphone in her right hand, ShaCorrie told 50 demonstrators sitting on the lawn about her eight-month efforts to secure help for her husband. She had contacted the Washington State Department of Public Health to complain about medical conditions within the center, and the Tacoma-Pierce County Health Department to notify them of a chickenpox outbreak — what she and other organizers believe is the second one in 2018. She’d also contacted U.S. Senators Maria Cantwell and Patty Murray’s offices, as well as the City Council of Tacoma, but the politicians she’d spoken to hadn’t yet heeded her concerns, she said. “At this point I’m just like, ‘What else is there to do?’” ShaCorrie implored the crowd. “The case I want [officials] to look at is that it’s a human being.”

At the end of the rally, demonstrators crouched down to a large white scroll stretched across the sidewalk to write messages for people in detention. Others marched around the periphery of the center in hopes that people inside would hear their chants.

“Momma, are we going to see daddy today?” ShaCorrie’s 9-year-old daughter asked, to which she promised they would. The kids see their father every weekend, ShaCorrie shared during a walk around the outside of the detention center; the family usually places their hands on the opposite sides of a glass partition in a visitation room inside the facility and blow each other kisses, stealing a brief connection between their two drastically different worlds. While the meet-ups initially inspired a lot of crying from the kids, “they’ve adjusted to it pretty well,” ShaCorrie remarked as she stood by the center’s fence. “That’s just the way it is.”

ShaCorrie’s persistence in ensuring her husband receives proper medical attention has continued in her attempts to secure him a green card through her U.S. citizenship. She went alone to a green card interview conducted by a U.S. Citizenship and Immigration Services officer in mid-September, because Tunkara said ICE would not allow him to attend the meeting.

The stress has also taken a toll on Tunkara’s mental health, he said, noting that he hears voices that tell him not to trust others. “I don’t want to die in here,” Tunkara said resolutely at the end of a recent video interview. “I want other people to hear my story.” A timer to the right of the screen indicated that the call was expiring; he suddenly disappeared from view as the video transitioned to black.